Care and support for people living with HIV/AIDS

Report on the global HIV/AIDS epidemic – June 2000personnel, but few countries have as yet fully understood the epidemic’s impact onhuman resources in their health sector. A study in Zambia showed that in one hospital,deaths in health care workers increased 13-fold over the 10-year period from1980 to 1990, largely because of HIV. As in other sectors of the economy, risingrates of HIV infection in health care workers will increase rates of absenteeism,reduce productivity, and lead to higher levels of spending for treatment, death benefits,additional staff recruitment and training of new health personnel.Impact on agricultureAgriculture is one of the most important sectors in many developing countries, particularlywhen measured by the percentage of people dependent on it for their living.Although the sector may produce only 20% of a country’s wealth (measured asa percentage of the gross national product), it might provide a living or survival foras much as 80% of the country’s population. Indirectly, it provides a livelihood forstill other parts of the population, such as processing workers on sugar estates (see“The bottom line”, below).The effect of AIDS is devastating at family level. As an infected farmer becomesincreasingly ill, he and the family members looking after him spend less and lesstime working on his family’s crops. The family begins to lose income from unmarketedor incompletely tended cash crops, has to buy food it normally grows foritself, and may even have to sell off farm equipment or household goods to survive.The vicious circle is compounded by the high costs of health care, whether the sickperson turns to a traditional healer or to the health services. A 1997 study by theFood and Agriculture Organization of the United Nations (FAO) showed that in themid-west of Côte d’Ivoire, care for male AIDS patients cost on average aboutUS$ 300 a year, representing a quarter to a half of the net annual income of mostsmall-scale farms.The time lost by family members must also be taken into account. For instance, therepeated absence of another member of the farm to accompany the patient to ahealer also reduces the farm’s production. And when the most debilitating phasesof AIDS coincide with key farming periods such as sowing or clearing, the timespent nursing a sick person and lost to farm labour is sorely missed. A recent surveyin the rural Bukoba district of the United Republic of Tanzania found a radicalshift in the allocation of labour time: a woman with a sick husband spent 60% lesstime on agricultural activities than she would normally do.Altogether, the effects on production can be serious. In West Africa, many caseshave been reported of reduced cultivation of cash crops or food products. Theseinclude market gardening in the provinces of Sanguié and Boulkiemdé in BurkinaFaso and cotton, coffee and cocoa plantations in parts of Côte d’Ivoire. A recentstudy in Namibia by the FAO concluded that the impact on livestock is considerable,with a heavy gender bias: households headed by women and children gener-32